Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY003915 | GA |
Y | 103T00000X | Psychologist | PSY003915 | GA |
NPI | 1013129956 |
---|---|
Provider Name | Dr. Jacqueline Luann O'connell |
First Address | Woodstock, GA 30188-4916 |
Second Address | Woodstock, GA 30188-4916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 24/08/2015 |